- Pregnancy and vaginal birth
- Family history
- Increased age
Urinary incontinence is a condition whereby urine involuntarily leaks out from the bladder. It can occur either in short episodes or long-term. Some people with incontinence will have to make changes to their lifestyle, so it can have a significant impact on daily life.
Bladder control problems are very common, especially in women. In most cases, it can be treated effectively. It affects women of all ages but is most prevalent in those who have reached menopause. It will often affect young women who are pregnant or have recently given birth. In some cases, it will not develop until a woman is over the age of 70.
Apart from gender and age, there are a number of other risk factors for urinary incontinence. One is family history. You will tend to have a higher risk of incontinence if people in your immediate family have also had bladder problems.
Incontinence is also connected to a group of medical symptoms called lower urinary tract symptoms (LUTS). These become more common with age and tend to affect older men more than older women. In men, LUTS can sometimes occur due to problems with the prostate, though this is not necessarily the case.
The bladder is controlled by a muscle called the detrusor and supported by the pelvic floor. To release urine from the urethra, the detrusor contracts, and the pelvic floor relaxes. This normally occurs voluntarily, and only when the bladder is nearly full.
Incontinence occurs when the detrusor contracts earlier than normal. This results in an urge to urinate, even though the bladder is not full.
Stress incontinence occurs when there is a sudden increase in the pressure on the muscles around the bladder. Normally, the pelvic floor prevents the leakage of urine by supporting both the bladder and the urethra. A lack of urethral support can cause urine to leak, as can a weakness in the urethral wall itself. Obesity, menopause, and pregnancy can all weaken these muscles. Muscle or tissue weakness due to these conditions is called ‘genuine stress incontinence’.
Less frequently, a small amount of urine may leak when there is sudden pressure on pelvic muscles from activities such as heavy lifting, coughing, laughing or sneezing. Although this usually only causes a small leakage, a bigger amount of urine may leak if the bladder is nearly full.
Urge incontinence is a sudden and desperate need to urinate. You may find yourself unable to find a toilet between the onset of the urge and the release of urine. This occurs when the bladder muscle, or detrusor, is overactive and contracts before the bladder is full. If you have an overactive bladder, you may find yourself needing to pass urine much more often than normal, including during the night.
There is often no specific cause as to why the bladder muscle is overactive. Some people with urge incontinence will pass urine following a sudden movement or during sex, especially near the point of orgasm.
In many cases, stress and urge incontinence will result in similar symptoms. So, it may be difficult at first to identify what is causing your incontinence.
Generally, urge incontinence is leakage that follows a sudden desperate need to pass urine – this can happen during the day or at night. It can involve a large amount of urine. Stress incontinence involves only a small amount of urine and tends not to occur at night. However, because severe stress incontinence can resemble the symptoms of urge incontinence, they are difficult to conclusively identify based on symptoms alone.
A ‘cough test’ might help you to see whether pressure such as coughing causes leakage. Again, however, this will not be conclusive.
If your incontinence persists following some basic treatments, your GP might recommend further tests to identify the nature and cause of the incontinence. This can include an ultrasound of the bladder or the creation of a frequency/volume chart. You might also be advised to have a urodynamics test – this involves small instruments being placed in the bladder and the rectum in order to measure the pressure in each.
In many cases, incontinence is a sudden condition which resolves itself after a short while. There are a number of possible causes of temporary incontinence, such as:
Stress incontinence occurs due to a weak pelvic floor, which can come about due to obesity. Consider losing weight if you think it might be partially causing your incontinence.
Otherwise, there are a number of exercises that can help build up the strength of the pelvic floor. These need to be done regularly and correctly to remain effective. Some aids, such as biofeedback machines, are available to enhance these exercises. Research these exercise and aids thoroughly, and consider seeing a physiotherapist for further assistance.
Women with urge incontinence may be prescribed medications such as:
Each of these medications will be most effective if you also reduce your alcohol and caffeine consumption. Side effects may include dry mouth or constipation.
There are three types of operation that can enhance urethral support and hence treat incontinence. They may improve symptoms of incontinence, but each may cause complications. It is important that you thoroughly consult your GP before pursuing surgery.
The most popular involves surgically implanting transobturator tape, a thin strip of synthetic material, to cradle the urethra and remove pressure.
The more traditional method for women is Burch colposuspsions, a procedure whereby stitches are inserted near the neck of the bladder to provide support and ensure that it remains closed under pressure.
Finally, there are some procedures that involve injections which increase the strength of the urethral wall.
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